JP2020503156A - Guide and osteotomy instrument for flexible bone drill - Google Patents

Abstract

Flexible bone comprising a first body (2) having a through channel (4) therein and a hollow second body (3) into which the first body (2) can be inserted. A guide for a drill, wherein the second body (3) has a through hole (6) adapted to be placed in fluid connection with an internal through channel (4) of the first body (2). ), Wherein the second body (3) and the first body (2) slide together to change the relative position of the hole (6) with respect to the through channel (4). Thus, the penetration channel (4) of the first body (2) is also inserted and changes the exit angle (α) of the flexible bone drill (10) coming out of the through hole (6) of the second body (3). [Selection diagram] Fig. 1

Description

  The subject of the present invention is a guide for a flexible bone drill.

  Furthermore, the invention relates to an osteotomy instrument, in particular to an instrument with a flexible bone drill, preferably used in arthroscopic surgery on the hip or shoulder.

  However, the use of instruments for other parts of the body is not excluded.

  Such instruments are used to replace or replace hip prostheses in surgery to remove pathological or congenital bone augmentation, particularly for the hip or shoulder, or when preliminary cleaning of the acetabular cup is required. Especially useful during surgery.

  A femoral acetabulum collision, or impingement, is a series of congenital or acquired disorders due to imperfect structure and abnormal contact between the hips (proximal to the femur). Caused by hip lesions.

  The femoral head is usually spherical and articulates in the cup (acetabular) without friction or contact (impingement).

  The incomplete fit of one or both of the femoral head and the acetabulum results in a state of friction known as femoral acetabulum impingement (FAI). The first type of femoral acetabulum impingement can be due to the abnormal curvature of the femoral neck with osteophytes near the neck on the surface surrounding the femoral head, which can interact with the acetabular lip. Acts and damages. A second type of impingement can be caused when the acetabulum is abnormally pincer-shaped. Again, there is interference between the femoral neck and the acetabular lip.

  Femoral acetabulum impingement is one of the most frequent causes of arthropathy of the hip, and typically affects young adults and athletes alike, but it affects people with sedentary lifestyles. Such deformations may go unnoticed throughout life.

  The exacerbation of this condition is due to the repetitive strain applied to repeat and force the extreme movement.

  If diagnosed early, the condition can be treated before the joint is damaged, and the prognosis of patients affected by the condition can be improved.

  To that end, arthroscopic surgery is performed to restore the correct femoral head-to-neck offset ratio by removing cervical bone formation.

  Currently, some arthroscopic instruments are used, typically powered bone drills, which can be inserted at the site of a surgical procedure to reach the bone augment to be removed at a preset approach angle, or It has a preset curvature to guide the flexible drill to where you want to operate it. However, in addition to involving the use of some instruments, such techniques do not provide surgeons with a high degree of flexibility when handling drills during surgery.

  Another situation that requires removal of a bony prosthesis is the installation or replacement of a hip prosthesis.

  For the first hip replacement, once the femur is removed, the concave surface of the acetabular cup is uneven and uneven, and must be smoothed before the prosthesis is installed. Similarly, in the case of revision surgery, after removing the old acetabular cup, which will generally become osteointegrated with the rest over time, the acetabular surface will bulge around the cup and must be removed You will have osteophytes that do not have to.

  Before installing the prosthesis, the acetabular sheet must not only be thoroughly cleaned to smooth its surface, but also make it impossible for the edge of the acetabular to reach the bottom of the acetabulum. It must not have any osteophytes that could prevent the correct orientation of the final cup.

  Surgeons are currently using semi-circular bone drills with a handle having a convex outer surface with a roughness designed to remove osteophytes.

  The bone drill is inserted into the acetabulum and manually operated to rub the concave surface of the acetabular cup using a rough convex surface.

  Applicants have discovered that bone drills of the type known in the prior art require the surgeon to have excessively reduced mobility of the instrument during surgery, the need to use several instruments, and the use of arthroscopy and other surgical tools. It has been found that it has several disadvantages associated with the need to have more flexible instruments that can be used in surgery.

  Therefore, the applicant has concluded that it would be much more advantageous to be able to use a single instrument to allow the tilt angle to be arbitrarily defined for operating on a bone process to be removed.

  Accordingly, it is an object of the present invention to provide a guide and osteotomy instrument for a flexible bone drill that can overcome the disadvantages of the prior art described above.

  More precisely, it is an object of the present invention to provide a guide for a flexible bone drill that allows the drill to be easily positioned and used effectively during surgery.

  It is a further object of the present invention to remove osteophytes in the case of femoral acetabular impingement or shoulder impingement and to remove acetabular sheets as needed to clean the acetabular sheet to install a prosthesis. To provide equipment.

  Finally, it is an object of the present invention that the surgeon has great flexibility of operation by allowing the surgeon to adjust the tilt angle at which the drill acts on osteophytes during surgery according to each patient's anatomy. And at the same time prevent the drill from accidentally interfering with soft tissue or bone structures that must not be removed or damaged by accidental contact with the power tool, thereby maximizing patient safety. To produce a guaranteed osteotomy instrument.

  These and other objects of the present invention are substantially achieved by a guide and osteotomy instrument for a flexible bone drill of the type described in one or more of the following claims. The dependent claims describe some alternative embodiments of the invention.

  In any case, these and further features and their respective technical advantages are described below in preferred non-exclusive embodiments of guides and osteotomy instruments for flexible bone drills, given only by way of non-limiting example. Will be more apparent from the description.

  This description is provided with reference to the accompanying drawings, which are also provided only as non-limiting examples.

1 is a perspective view of a guide for a bone drill according to the present invention. FIG. 2 is a cross-sectional view of an osteotomy instrument provided with the guide shown in FIG. 1. FIG. 4 is a perspective view of a first main body of the guide according to the present invention. FIG. 4 is a sectional view of a first main body shown in FIG. 3. FIG. 4 is a perspective view of a second main body of the guide according to the present invention. It is sectional drawing of the 2nd main body shown in FIG. FIG. 3 is a perspective view of a control element that is part of a guide according to the present invention. FIG. 3 is a perspective view of a control element that is part of a guide according to the present invention.

  Referring to the accompanying drawings, generally designated by the reference numeral 1 is a guide for a flexible bone drill according to the present invention.

  The guide 1 has a first body 2 and a second body 3 that can be inserted one inside the other and are movable with respect to each other.

  The guide preferably extends substantially longitudinally, advantageously in cylindrical form, along the axis 1a.

  The second body 3 is hollow inside and has an open first end 3 ′ into which the first body 2 is inserted, and a second end 3 ″ opposite to the first end. And

  The first body 2 also has an open first end 2 ′ and a second end 2 ″ opposite to the first end, which is inserted into the second body 3. .

  The first body 2 has a portion from the outer first end 2 ′ of the second body 3 along the longitudinal axis 2 a to the intermediate point 5, partially on the longitudinal axis 2 a of the first body 2. An internal through-channel 4 is provided which comprises an axial portion 41 extending therefrom and a lateral portion 42 extending from the midpoint 5 along the longitudinal axis 2a towards the side wall 2c of the first body 2.

  Advantageously, the transverse portion 42 is inclined with respect to the longitudinal axis 2a of the first body 2 at a variable angle α of 30 ° to 80 °, preferably 40 ° to 60 °.

  The axial portion 41 and the lateral portion 42 are in communication, continuous, and in fluid connection with the external environment.

  As shown in FIG. 4, the axial portion 41 of the channel 4 communicates outwardly through the first free end 2 ′ of the first body 2, whereas the lateral portion 42 of the channel 4 is From the side wall 2 c of the main body 2.

  Instead, one side wall 3c of the second main body 3 is provided with a through hole 6 arranged to be in fluid communication with the internal cavity 30. When the guide is attached, the hole 6 is arranged to be in fluid connection with the through channel 4 in the first body 2.

  The second main body 3 may have a lightening slit 40 along the side wall 3c.

  The first body 2 and the second body 3 slide together to change the position of the hole 6 of the second body 3 with respect to the through channel 4 of the first body 2.

  Guide 1 cooperates with flexible scraping element 10 to define an osteotomy instrument.

  The flexible scraping device 10 is preferably a flexible bone drill suitable for being inserted into the guide 1. Advantageously, the bone drill is, for example, made of Nitinol.

  Specifically, the scraping element 10 passes through the axial portion 41 and the lateral portion 42 of the channel 4 and emerges from the second body 3 through the through-hole 6 so as to emerge from the first end 2. 'Can be inserted into the channel 4 of the first body 2.

  The exit angle β of the scraping element from the guide 1 can be adjusted by adjusting the axial position of the first body 2 with respect to the second body 3.

  Advantageously, the exit angle β of the flexible scraping element 10 passes through the bore 6 varying between 60 ° and 90 ° with respect to an axis 6a perpendicular to the longitudinal axis 1a of the guide.

  The guide 1 further limits the axial relative movement between the first body 2 and the second body 3 to prevent the first body 2 from accidentally coming off the second body 3 and to rotate. In the direction, there is provided a movement restricting means 7 suitable for preventing relative rotation of one with respect to the other about the rotation axis 2a.

  Said limiting means 7 can also control the relative movement between the first body 2 and the second body 3 in both the axial and rotational directions.

  The movement restricting means 7 includes an anti-rotation device 20 including a pin 8 protruding outward from the side wall 2 c of the first main body 2 and a slot 9 obtained in the side wall 3 c of the second main body 3.

  The pin 8 is movable inside the slot 9 so as to prevent any relative rotation between the first body 2 and the second body 3.

  Said device 20 actually prevents the relative rotation of the first body 2 with respect to the second body 3 about the longitudinal axis 1a of the guide 1, so that the hole 6 is always lateral to the channel 4. Radially coincides with the directional portion 42 to prevent any deformation, undesired bending or tearing of the scraping element 10.

  The anti-rotation device 20 further defines a bayonet-type joint for connecting the first body 2 to the second body 3. As can be seen in FIG. 5, in this configuration, the slot 9 is such that the first straight part 9 ′ and the pin 8 opening towards the first end 3 ′ of the second body 3 are inserted in the locked position. It may be hook-shaped with a second arch portion 9 ''.

  According to a preferred embodiment, not shown, there may be a straight slot 9 closed at both ends, in which the pin 8 can slide.

  The movement restricting means 7 further includes a restraining device 300 for preventing the first main body 2 and the second main body 3 from coming off completely from each other. The restraint device 300 allows for a limited relative axial translation between the two bodies.

  Specifically, the restraint device 300 includes an annular flange 200 extending radially from the first body 2.

  The annular flange 200 is integral with the first annular body 2 and thus follows its axial translation.

  Disposed outside the first body 2 and the second body 3 is a sleeve 11 removably restrained by the second body 3.

  An annular flange 200 is obtained inside the sleeve 11 and is movable in a housing 12 extending between an end 11 ′ of the sleeve 11 and a first end 3 ′ of the second body 3.

  An elastic element 13, preferably a coil spring, is housed between the annular flange 200 and the first end 3 ′ of the second body 3. The elastic element 13 can be used in the compression stage when the first body 2 is inserted into the second body 3 and in the expansion stage when the first body 2 is withdrawn from the second body 3. It allows a controlled and limited axial movement of the first body 2 within the second body 3.

  The sleeve 11 is also part of the control device 15, whose purpose is to operate the guide 1 and to controllably move the first body 2 relative to the second body 3.

  The control device 15 further comprises a first thread 14 arranged around the second body 3 and capable of engaging with the second internal thread 16 of the sleeve 11.

  When the sleeve 11 is screwed into the thread 14 of the second body 3 with its screw 16, it acts on the annular flange 200 via its end 11 ′ and the first body 2 inside the second body 3. push.

  The annular flange 200 presses the spring 13 against the first end 3 ′ of the second body 3. The effect of the spring 13 is to slow down and control the movement of the first body inside the second body and to withdraw the first body from the second body 3 when the sleeve 11 is operated in the opposite direction. It is to make it easier.

  Simply operating the control device 15 and thus screwing or unscrewing the sleeve 11 from the second body 3 results in a relative translation of the first body 2 with respect to the second body 3.

  The relative axial position between the lateral part 42 of the channel 4 and the outlet hole 6 of the second body 3 is determined, so that how much the first body 2 is inserted into the second body 3 The inclination of the scraping element 10 changes depending on whether or not it is.

  The above-described invention achieves several important advantages.

  In the guide according to the invention, the exit angle of the flexible scraping element is simplified by acting in a controlled manner on the control device in order to change the relative axial position of the first body with respect to the second body. Can be adjusted. In this way, the surgeon can operate in a precise and targeted manner at the surgical site to remove the bone overhang and prepare the area for receiving a new prosthesis.

Claims (15)

  Flexible body comprising a first body (2) having a through channel (4) therein and a second body (3) having a hollow interior into which said first body (2) can be inserted. A guide for a bone drill, wherein said second body (3) is adapted to be arranged in fluid connection with said internal through channel (4) of said first body (2). A through hole (6) is provided, and the second body (3) and the first body (2) slide with respect to each other to position the hole (6) relative to the through channel (4). A guide to change.   The internal through channel (4) is at least partially along a longitudinal axis (2a) of the first body (2), a first free end (2 ') of the first body (2). An axial portion (41) extending from the intermediate point (5) along the longitudinal axis (2a) to the first body (2) from the intermediate point (5) along the longitudinal axis to the intermediate point (5). The guide according to claim 1, comprising a lateral portion (42) extending towards the side wall (2c).   The transverse portion (42) is inclined at an angle (β) of 30 ° to 80 °, preferably 40 ° to 60 ° with respect to the longitudinal axis (2a) of the first body (2). The guide according to claim 2, wherein   The guide according to claim 2 or 3, wherein the axial portion (41) and the lateral portion (42) are in communication, continuous and in fluid connection with an external environment.   The axial portion (41) communicates outward through the first free end (2 ') of the first body (2) and the lateral portion (42) communicates with the first body (2). 5. Guide according to claim 2, wherein the guide communicates outwardly from a side wall of the guide.   6. The device according to claim 1, further comprising a movement limiting means adapted to limit and control relative movement between the first body and the second body in both an axial direction and a rotational direction. Guide described in section.   The side wall (1) of the first body (2) such that the movement limiting means (7) prevents any relative rotation between the first body (2) and the second body (3). An anti-rotation device comprising a pin (8) projecting outward from 2c) and a slot (9) formed in a side wall (3c) of the second body (3) for receiving the pin (8). The guide according to claim 6, comprising (20).   The guide according to claim 7, wherein the anti-rotation device (20) constitutes a bayonet-type joint for connecting the first body (2) to the second body (3).   The movement restricting means (7) prevents the first main body (2) and the second main body (3) from coming off completely from each other, and the first main body (2) and the second main body (2) The guide according to claim 6, comprising a restraining device (300) allowing a limited relative axial translation between the bodies (3) of the guides.   A sleeve (11) extending radially from the first body (2) and disposed outside the second body (3) and connected to the second body (3); ) Comprising an annular flange (200) movable within a resulting housing (12), said housing (12) comprising an end (11 ') of said sleeve (11) and said second body ( 10. The guide according to claim 9, wherein the guide extends between the first end of (3) and (3 ').   Said limiting means (7) comprises an elastic element (13) arranged between said annular flange (200) and said first end (3 ') of said second body (3); A resilient element (13) controls and limits the axial movement of the first body (2) within the second body (3), and the first body (3) from the second body (3). The guide according to claim 10, which facilitates a partial withdrawal of the body (2) of the guide.   The first body (2) for axially moving the first body (2) relative to the second body (3) in a controlled manner by actuating the guide (1); The guide according to one of claims 1 to 11, comprising a control device (15) comprising a sleeve (11) arranged around the second body (3).   A first thread (14), wherein the control device (15) is arranged around the second body (3) and can engage with a second internal thread (16) of the sleeve (11); The sleeve (11) is screwed into the thread (14) of the second body (3) to move the first body (2) via its end (11 '). 13. The guide according to claim 12, wherein the first body (2) is pushed inside the second body (3).   14. A flexible bone drill guide according to one or more of claims 1 to 13 and a flexible rotary scraping element (10) insertable into said guide (1), said flexible The sex scraping element (10) has an exit angle (α) from the guide (1) according to the relative position of the guide (1) between the first body (2) and the second body (3). An osteotomy instrument that can be changed. The outlet angle (α) of the flexible scraping element (10) is between 60 ° and 90 ° with respect to the central axis (6a) of the through hole (6) of the second body (3). 15. The osteotomy instrument of claim 14, wherein the instrument varies.

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